The echinocandin antifungals: An overview of the pharmacology, spectrum and clinical efficacy

Nathan P. Wiederhold, Russell E. Lewis

Research output: Contribution to journalReview articlepeer-review

118 Scopus citations

Abstract

For over four decades, the principal target of antifungal therapy has been the fungal cell membrane sterol ergosterol. Although this has proven to be a successful and relatively selective antifungal target, collateral toxicity to mammalian cells (amphotericin B) and drug interactions (azoles) have been by-products of agents that target the fungal cell membrane. In the 1970s, the echinocandins were identified during the screening of fungal fermentation products for new antibiotic agents. These agents were subsequently shown to inhibit production of β(1,3)-glucan, a key structural component of the fungal cell wall. Subsequent chemical modification of these natural products has led to the development of safer, semi-synthetic β(1,3)-glucan synthase inhibitors with enhanced microbiological and clinical efficacy against infections caused by Candida and Aspergillus species. In this review, the pharmacology, spectrum and clinical efficacy of the three leading β(1,3)-glucan synthase inhibitors (caspofungin, micafungin and anidulafungin), which have completed phase III clinical trials, will be discussed and a perspective for the role of these agents in the management of life-threatening mycoses will be offered.

Original languageEnglish (US)
Pages (from-to)1313-1333
Number of pages21
JournalExpert Opinion on Investigational Drugs
Volume12
Issue number8
DOIs
StatePublished - Aug 1 2003
Externally publishedYes

Keywords

  • Anidulafungin
  • Aspergillus
  • Candida
  • Caspofungin
  • Micafungin

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

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